Rationale: Nitroglycerin (NTG) is a definite usually prescribed short-acting anti-anginal and antihypertensive medication. But historically, it is an unknown antiarrhythmic drug. Nitroglycerin is attenuating anginal symptoms in ischemic heart disease (IHD). Ischemic heart disease is a reasonable remarkable cause of premature ventricular contractions (PVCs) and trigeminy. Simultaneous co-presence of both the stented myocardial infarction with premature ventricular contractions trigeminy is extremely rare.Patient concerns: An elderly, heavy cigarette smoker, the male patient presented to emergency department with trigeminal premature ventricular contractions with hypertensive crises and transient ischemic attack (TIA) in stented myocardial infarction.Diagnosis: Trigeminal premature ventricular contractions with hypertensive crises and transient ischemic attack in stented myocardial infarction.Interventions: Nitroglycerin intravenous infusion, critical care monitoring, electrocardiography, and percutaneous transluminal coronary angioplasty, and echocardiography.Lessons: Clearing the efficacious role of nitroglycerin as an antiarrhythmic medication in ischemic trigeminal premature ventricular contractions.Outcomes: Dramatic termination of trigeminal premature ventricular contractions with nitroglycerin intravenous infusion strengthen its antiarrhythmic effect. The presence of myocardial infarction, hypertensive crises, transient ischemic attack, elderly, cigarette smoking, and premature ventricular contractions are prognostic factors for the severity of structural heart disease.